Covered Services

Covered Services A. Family Planning Waiver (FPW) services are available for eligible participants who voluntarily choose to: 1. Prevent pregnancy, 2. Plan the number of pregnancies, or 3. Plan the spacing between pregnancies. B. FPW services are limited to four (4) visits annually between January 1 through December 31 and include: 1. A one (1) time initial visit defined as the first time a participant receives family planning services from a provider and must be billed using the appropriate preventive medicine code and include: a) The establishment of a medical record, b) An in-depth evaluation including a complete medical history, c) A complete physical examination, including a clinical breast exam and cervical cancer screening, according to nationally recommended guidelines, d) Establishment of baseline laboratory data, e) FPW counseling and education which includes contraceptive and sexually transmitted disease (STD) prevention information, and f) Issuance of supplies or prescriptions covered under the FPW. 2. An annual visit defined as the re-evaluation of an established participant the next year following the one (1) time initial evaluation and must be billed using the appropriate preventive medicine code and include: a) An update to the medical record, b) Interim history, c) Complete physical examination, including a clinical breast exam and cervical cancer screening, d) Appropriate diagnostic lab tests or procedures, e) FPW services management, education and counseling, and f) Renewal or change of contraceptive prescriptions or supplies. 3. A follow-up visit is defined as an evaluation of an established participant with a new or existing family planning or family planning related issue, and must be billed using the appropriate evaluation and management code and include: a) An evaluation of the participant’s contraceptive program, b) Renewal or change of the contraceptive prescription or supplies, and c) Additional opportunities for counseling and education regarding reproductive health and family planning and family planning related issues. C. FPW only covers the following drugs and supplies: 1. Prescription oral contraceptive agents, 2. Contraceptive patches, 3. Self-inserted contraceptive products, 4. Injectable contraceptives dispensed in the pharmacy venue and administered in the provider’s office, 5. Contraceptive injections purchased by the provider and administered in the provider’s office, 6. Medications for the treatment of a sexually transmitted infection (STI)/ STD identified or diagnosed during a routine or periodic FPW visit except for human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) and hepatitis, 7. Medications and/or treatments for vaginal infections or disorders, other lower genital tract and genital skin infections or disorders, and urinary tract infections when these conditions are identified or diagnosed during a routine or periodic FPW visit, and 8. Condoms provided and billed by the provider separately on the medical claim. D. Covered contraceptive devices include: 1. Insertion, removal, and removal with reinsertion of a contraceptive intrauterine device, 2. Insertion, removal, and removal with reinsertion of a contraceptive implant, 3. Diaphragm or cervical cap fitting with instructions, and 4. Vaginal rings. E. Voluntary vasectomy and tubal ligation procedures, including tubal sterilization by hysteroscopy, and all necessary follow-up procedures if the criteria in Miss. Admin. Code Part 202, Rule 5.3 is met. F. Laboratory procedures that must be conducted during initial and annual visits include the following: 1. Blood count, 2. Pap smear according to nationally recommended guidelines for cervical cancer screening, 3. Screenings for STI/STD and HIV/AIDS, and 4. Pregnancy test, as indicated.